tbuckley/cabot-search huggingface dataset:
Abstract 08: Prevalence and Patterns of Cardiovascular Multimorbidity in Black and White Adults at Midlife: The Bogalusa Heart Study
Authors: Shirine Moukaled, Ileana De Anda-Duran, Kaitlin Potts, Camilo Fernandez Alonso, Lydia A Bazzano
Journal: Circulation (2023)

Background: Multiple chronic conditions, primarily of cardiovascular origins, are a major cause of disability, death, and health care spending. Cardiovascular multimorbidity is also associated with multiplicative risk of morality and substantially lower life expectancy, which may exacerbate health disparities. However, its impact in a rural and low socioeconomic community with a high proportion of minorities is understudied. We aimed to describe multimorbidity prevalence and patterns by race, sex, and socioeconomic status in a middle-aged, community-based cohort. Methods: We examined 1,298 Black (35%) and White (65%) individuals (mean age 48.17 ± SD 5.27 years; 59% female) from the Bogalusa Heart Study, a rural, community-based, longitudinal cohort in Bogalusa, Louisiana, between 2013 and 2016. Eight chronic conditions (CCs) selected based on CMS (Centers for Medicare &amp; Medicaid Services) guidance were defined using data from self-reported medical history, medication use, and physiological or laboratory measures. We defined multimorbidity as the coexistence of two or more of these conditions. The prevalence of cardiovascular multimorbidity and the most commonly occurring dyads and triads were assessed by race, sex, and socioeconomic factors using chi-square tests. Results: We found that 70% of the 1,298 participants had ≥2 CCs, while 31% had ≥3 CCs. The most prevalent conditions were dyslipidemia (87.9%, n=1,141), hypertension (66.6%, n=864), and diabetes (19.7%, n=255). The prevalence of multimorbidity was higher in Black than in White (76.8%, n=344 vs. 66.5%, n=565; p&lt;0.01) participants and higher in men than in women (73.6%, n=393 vs. 67.5%, n=516; p&lt;0.02). Hypertension and dyslipidemia made up the most prevalent dyad (33.0%, n=413), while hypertension, dyslipidemia, and diabetes made up the most prevalent triad (9.4%, n=116). Multimorbidity prevalence was significantly higher among participants with government issued insurance compared to private insurance (80.7%, n=267 vs. 64%, n=427; p&lt;0.001), and more common among lower income compared to higher income (74.6%, n=390 vs 65.4%, n=397; p&lt;0.01), respectively. Conclusion: Cardiovascular multimorbidity is highly prevalent in midlife among participants of the Bogalusa cohort compared to national and even state-wide levels. These findings have critical public health ramifications and support the need to better study multiple CCs in rural, underserved populations to create tailored interventions that are effective among adults in their most productive years of life despite geographic and income barriers.
Abstract P202: Proteomic Markers Associated With the Risk of Incident Hypertension in the Community: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Lena M Mathews, Xiao Hu, Frances Wang, Jingsha Chen, Bing Yu, Ron C Hoogeveen, Christie M Ballantyne, Elizabeth Selvin, Amil M Shah, Chiadi E Ndumele, Josef Coresh, Kuni Matsushita
Journal: Circulation (2023)

Introduction: Proteins are involved in the pathophysiology of hypertension (HTN), but there are no large scale prospective proteomic analyses of incident HTN. Hypothesis: To identify and validate plasma proteins associated with incident HTN among a bi-racial cohort in the US. Methods: We quantified the associations of 4,955 plasma proteins (measured by SomaScan version 4 assay) with incident HTN over median follow-up of 11 years among 5,080 participants without baseline hypertension at ARIC visit 3 (1993-95). We then validated significant proteins from the primary analysis with incident HTN between visit 2 (n=6,810 during 1990-92) and visit 3 (median follow-up of 3.1y), to avoid including the same incident HTN cases in both analyses. Incident HTN was defined as systolic blood pressure (BP) ≥140, diastolic BP ≥90 mmHg, or HTN medication use. We ran multivariable Cox models and applied Benjamin-Hochberg procedure, with false discovery rate of 0.05, to account for multiple comparisons. Results: In the primary analysis with visit 3 as baseline (mean age 59y, 54% women, 13% Black), 3,828 participants (75%) developed HTN, and we found 55 proteins significantly associated with incident HTN. Among them, 14 proteins were validated using visit 2 data (Figure). Of those, 11 showed positive associations with HTN, and they are involved in glycoprotein degradation (e.g., MMP7, HTRA1, ASGR1, GUSB, CPM), cell adhesion (e.g., LGALS3BP and RET), and inflammation (e.g., CRP). In contrast, 3 proteins, renin ([REN]), netrin receptor ([UNC5D] apoptosis) and secretogranin-3([SCG3] endothelial cell growth), had inverse relationships with incident HTN. Further exploration showed a U-shaped association between renin and incident HTN. Conclusion: We identified several proteins associated with incident HTN, with plausible functions contributing to the development of HTN. These findings have implications on understanding mechanisms of HTN and potential targets for prevention and treatment.
Abstract 24: Association of the Gut Microbiome With Kidney Function and Damage in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)
Authors: Brandilyn A Peters, Qibin Qi, Mykhaylo Usyk, Martha L Daviglus, Jianwen Cai, Nora Franceschini, James P Lash, Marc D Gellman, Bing Yu, Eric Boerwinkle, Rob Knight, Robert D Burk, Robert C Kaplan
Journal: Circulation (2023)

Background: The gut microbiome is altered in chronic kidney disease (CKD), potentially contributing to CKD progression and co-morbidities such as cardiovascular disease, but population-based studies of the gut microbiome across a wide range of kidney function and damage are lacking. Methods: In the Hispanic Community Health Study/Study of Latinos, gut microbiome was assessed by shotgun sequencing of stool (n=2,438; 292 with suspected CKD). We examined cross-sectional associations of estimated glomerular filtration rate (eGFR), urinary albumin:creatinine (UAC) ratio, and CKD with gut microbiome features, adjusting for covariates, and also stratified by diabetes status. Kidney trait-related microbiome features were interrogated for correlation with serum metabolites (n=700), and associations of microbiome-related serum metabolites with kidney trait progression were examined in a prospective analysis (n=3,635) ( Figure 1a ). Results: Higher eGFR was significantly associated with overall gut microbiome composition, greater abundance of species from Prevotella , Faecalibacterium , Roseburia , and Eubacterium , and microbial functions related to synthesis of long-chain fatty acids and carbamoyl-phosphate. Higher UAC ratio and CKD were related to lower gut microbiome diversity and altered overall microbiome composition only in participants without diabetes. Microbiome features related to better kidney health were associated with many serum metabolites (e.g., higher indolepropionate, beta-cryptoxanthin; lower imidazole propionate, deoxycholic acids, p-cresol glucuronide) ( Figure 1b ). Imidazole propionate, deoxycholic acid metabolites, and p-cresol glucuronide were associated with prospective reductions in eGFR and/or increases in the UAC ratio ( Figure 1c ). Conclusions: Kidney function is a significant correlate of the gut microbiome, while the relationship of kidney damage with the gut microbiome depends on diabetes status. Gut microbiome metabolites may contribute to CKD progression.
Abstract 35: Adherence to Life’s Essential 8, Genetic Susceptibility, and Incident Cardiovascular Disease: A Prospective Study of 137,794 UK Biobank Participants
Authors: Xiang Li, Qiaochu Xue, Hao Ma, Han Feng, Xuan Wang, Yoriko Heianza, Lu Qi
Journal: Circulation (2023)

Introduction: The American Heart Association recently introduced an enhanced approach to assess cardiovascular health (CVH): Life’s essential 8 (LE8). Sleep was included as a new component. The current study sought to analyze the relationship between levels of CVH, indicated by the LE8 score, and risks of coronary heart disease (CHD), stroke, and cardiovascular disease (CVD). Hypothesis: We hypothesized that higher CVH, indicated by the LE8 score, was associated with lower risks of CHD, stroke, and CVD; LE8 might also interact with genetic susceptibility. Methods: The current study included 137,794 participants free of CVD from the UK Biobank. CVH was scored at baseline by LE8 (DASH diet score, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure). The LE8 score ranged from 0 to 100; and was categorized as low (0-49), moderate (50-79), and high (80-100). Weighted genetic risk scores (GRS) for CHD and stroke were calculated. Cox proportional hazard model was used to assess the relationship between LE8 and incident CVD outcomes, and potential interaction with age, gender, and GRS. We also compared the performance of LE8 with Life’s Simple 7 (LS7) using Harrell’s C-index. Results: During a median of 10 years, 8,595 CVD cases (6,968 CHD and 1,948 strokes) were documented. A higher LE8 score was associated with remarkably lower risks of CHD, stroke, and CVD (p&lt;0.001 for all). Comparing the high CVH to the low CVH, the adjusted HRs (95% CI) were 0.34 (0.30, 0.38) for CHD, 0.45 (0.37, 0.54) for stroke, and 0.36 (0.33, 0.40) for CVD. Moreover, the model with LE8 achieved higher accuracy and outperformed the model with LS7 (C-index: 0.7417 vs. 0.7345, p&lt;0.001 for CHD, 0.7208 vs. 0.7165, p&lt;0.001 for stroke, and 0.7339 vs. 0.7276, p&lt;0.001 for CVD). The protective associations of the LE8 score with CVD outcomes were more pronounced among women (p-interaction &lt;0.001 for CHD and 0.0013 for CVD, respectively), and among younger adults (p-interaction &lt;0.001, 0.007, and &lt;0.001 for CHD, stroke, and CVD, respectively). In addition, we found a significant interaction between the GRS of CHD and the LE8 score (p-interaction &lt;0.001). The inverse association was stronger among those with a lower genetic risk of CHD. Conclusions: High level of CVH, defined by LE8, was associated with significantly lower risks of CHD, stroke, and CVD. Such relationships are more pronounced among women, younger adults, and people with a lower genetic predisposition.
Abstract P390: Trends in Contraceptive Prescribing in Women With Hypertension From 2017-2022
Authors: Katherine Sadaniantz, Gianna Wilkie, Lara Kovell
Journal: Circulation (2023)

Introduction: Estrogen based contraception is not recommended by the U.S. Medical Eligibility Criteria (MEC) in women with hypertension (HTN), regardless of control. While the CDC reports 65.3% of women of child-bearing age use contraception, little is known about rates of contraceptive prescriptions in women with HTN. Purpose: To examine contraceptive prescription patterns among women with and without HTN. Methods: Retrospective review of electronic health record (EHR) data through EPIC from a large health system was performed using a data extraction tool called EPIC SlicerDicer. All women aged 18-55 with HTN who presented to the health system from 2017-2022 were included. HTN, defined by ICD codes, included essential HTN, benign HTN, HTN in CKD due to T2DM, HTN in CKD III due to T2DM, HTN concurrent and due to end stage renal disease, HTN secondary to endocrine disorder, renovascular HTN, HTN with albuminuria, and secondary HTN. Contraceptive prescriptions were abstracted from the EHR including estrogen based contraception (combination oral contraceptive pills, patch, and ring), long acting reversible contraception (intrauterine device or implant), progestin only pills, and depo-provera. Results: Over 5 years, 33.5% (613 of 1,831) of women with HTN were prescribed contraceptives vs. 12.2% of women without HTN (77,742 of 637,820, p &lt; 0.001, Table ). Women with HTN prescribed contraceptives were mean age 43 (SD 9) years, 76.2% White, 9.3% Black, and 16.2% Hispanic/Latina. Women with HTN not prescribed a contraceptive were mean age 48 (7) years (p &lt; 0.001) with similar racial/ethnic background (p = 0.47). Among prescriptions for women with HTN, 37.7% were estrogen based. Conclusions: Women with HTN are prescribed effective contraception at a higher rate compared to the general population. Despite US MEC recommendations, over 1/3 of women with HTN are prescribed estrogen based contraception. Further efforts are warranted to encourage effective contraception counseling and prescription in this high-risk population.
Abstract 13: Circadian Misalignment is Associated With Impaired Heart Rate Variability in Adolescents
Authors: Natasha Morales-Ghinaglia, Fan He, Jason Liao, Susan Calhoun, Alexandros Vgontzas, Edward O Bixler, Duanping Liao, Julio Fernandez-Mendoza
Journal: Circulation (2023)

Introduction: Adequate sleep has been recognized by AHA as part of Life’s Essential 8 in the prevention of cardiovascular disease (CVD). The circadian system, which governs the sleep-cycle, is also involved in cardiac, metabolic and autonomic regulation. Heart rate variability (HRV), a marker of cardiac autonomic modulation (CAM), is known to predict CVD. As a result, circadian misalignment of the sleep-wake cycle, which is highly prevalent in adolescents, may impact CAM and be a potential risk factor for adverse CVD outcomes in early life. Hypothesis: We hypothesize that deviations in the circadian timing of sleep are associated with blunted HRV in adolescents. Methods: We analyzed data from 337 population-based randomly-selected adolescents from the Penn State Child Cohort (median 16 years; 47% female; 21% racial/ethnic minority) who had at least 3-night at-home actigraphy (ACT), in-lab 9-h polysomnography (PSG) and 24-h Holter-monitoring heart rate variability (HRV) data. ACT-sleep duration and sleep midpoint (SM) were calculated as the intra-individual mean total sleep time and midpoint of the sleep period, respectively. ACT-sleep variability and sleep regularity (SR) were calculated as the intra-individual standard deviation of sleep duration and sleep midpoint across nights, respectively. Frequency and time-domain HRV indices, including HR oscillations at high frequencies (HF), standard deviation between normal heart beats or R-R intervals (SDNN), and root mean square of successive differences between normal heartbeats (RMSSD), were primary outcomes. Linear regression models tested SM and SR as predictors of HRV indices, while accounting for sex, race/ethnicity, age, body mass index, ACT-sleep duration, ACT-sleep variability, and PSG-apnea/hypopnea index. Results: While there were no meaningful associations between SM or SR with daytime HRV, there were significant associations between SM with nighttime HRV. A later SM was associated with lower nighttime Log-HF, SDNN and RMSSD, yet higher nighttime LF/HF (all p&lt;0.03). For each standard deviation increase in SM (i.e., 1.5 hours later), there was a decrease of -5.50ms (1.92) in nighttime RMSSD (p=0.004). More specifically, the nighttime RMSSD of adolescents with a SM at 5:30 (i.e., sleep onset at 2:00, sleep offset at 9:00), was 18.2ms (6.7) lower (p=0.007) than that of adolescents with a SM at 2:30 (i.e., sleep onset at 23:00, sleep offset at 6:00). Conclusions: A delayed sleep phase is associated with impaired CAM in adolescents. These data support that circadian misalignment of the sleep-wake cycle may independently contribute to CVD risk.
Abstract P155: Modifiable Lifestyle Factors, Genetic Risk, and Incident Peripheral Artery Disease Among Individuals With Type 2 Diabetes: A Prospective Study
Authors: Frank Qian, Kai Zhu, Qi Lu, Rui Liu, Zixin Qiu, Lin Li, An Pan, Gang Liu
Journal: Circulation (2023)

Background: Individuals with type 2 diabetes (T2D) are at elevated risk of developing peripheral artery disease (PAD). Whether healthy lifestyle can reduce this risk, particularly in individuals genetically predisposed to PAD, is unknown. Aims: To evaluate the association between modifiable lifestyle factors with incident PAD among individuals with T2D, both overall and stratified by genetic risk of PAD. Methods: We included 19,368 individuals with T2D from the UK Biobank, who were free of PAD and cardiovascular disease. We defined a low-risk lifestyle score with 1 point assigned for each of the following: non-current smoking, regular physical activity, adhering to a high-quality diet, moderate alcohol consumption, maintaining a normal waist-hip ratio, sleeping 7-8 hours/day. A polygenic risk score (PRS) including 19 single nucleotide polymorphisms was constructed. Multivariable-adjusted Cox models were used to calculate the hazard ratio (HR) and 95% confidence interval (CI). Results: After a median 7.6 years of follow-up, 325 incident cases of PAD were documented. There was an inverse association between the low-risk lifestyle score and incident PAD, with HR (95%CI) of 0.73 (0.54, 1.03), 0.43 (0.30, 0.60), and 0.42 (0.30, 0.60) for 2, 3, and ≥4 compared with ≤1. The PRS was associated with an increased risk of PAD, with HR (95%CI) of 1.16 (1.03, 1.31) per-SD increment. A more favorable lifestyle was able to partially mitigate the risk of increased genetic susceptibility to PAD ( Figure 1 ). In mediation analysis, 42.4% of the association could be attributable to risk factors including inflammation, atherogenic lipoproteins, and impaired hepatic/renal function. Conclusion: A combined set of modifiable lifestyle factors was associated with a substantially lower risk of incident PAD among individuals with T2D and may be able to partially mitigate an underlying genetic predisposition for PAD. Our findings highlight the importance of improving adherence to these factors in the primary prevention of PAD among individuals with T2D.
Abstract 31: Associations Between Cardiorespiratory Fitness (CRF) in Early Adulthood, Retention Through Midlife, and Heart Failure (HF) Stages: Findings From Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Neela Thangada, Sam Gidding, Laura A Colangelo, Bjoern Hornikel, Sadiya Khan, Ambarish Pandey, Norrina B Allen, Stephen Sidney, Mercedes R Carnethon, Cora E Lewis, Donald Lloyd-Jones, Kelley P Gabriel
Journal: Circulation (2023)

Introduction: Prior studies demonstrate that poor CRF in early adulthood is associated with adverse cardiac structure and function in midlife. The purpose of this study is to examine if higher early adulthood CRF and retention of CRF through midlife are associated with lower subsequent risk of subclinical or clinical HF. Methods: CARDIA participants with available data on CRF at baseline (Year [Y] 0: 1985-86), follow-up (Y7 or Y20), and HF staging data by Y30 were included. CRF was estimated using treadmill duration from a maximal, symptom-limited graded exercise test via modified Balke protocol. An adjusted linear mixed model was used to estimate treadmill duration when CRF assessment was missing at Y7 or 20. HF stages were defined using AHA HF staging criteria, including Stage 0 (no HF risk factors). Clinical HF was adjudicated by committee. Adjusted multinomial models tested associations between Y0 CRF and percent CRF retained through Y20 with HF stages at Y30, with Stage 0 as the reference. Interactions by the four race-sex groups were examined. Results: Of 2,565 individuals (25.1±3.5 y, 43% Black, 55% female), 30% (n=778), 37% (n=952), 32% (n=813), and 1% (n=32) were classified as Stages 0, A, B, or C/D by Y30 exam, respectively. Compared with Stage 0, every 1-minute increment higher CRF in early-adulthood was associated with a lower adjusted odds ratio of HF [Stage A: 0.72 (95% CI 0.68, 0.76), Stage B: 0.80 (95% CI 0.75, 0.84), Stage C/D 0.86 (95% CI 0.71, 1.04)]. Compared with Stage 0, every 1-standard deviation of % CRF retained at Y20 (midlife) was also associated with a lower odds of Stage A, B, and C/D HF at Y30 (Figure). A race-sex interaction was not observed (p-interaction 0.42). Conclusion: Higher early adulthood CRF, and greater retention of CRF through midlife, were associated with lower risk of developing subclinical or clinical HF. Strategies to maintain optimal CRF across the young adulthood to midlife transition may be important in prevention of HF.
Abstract P607: What Do Consumers See? Nutrients Listed on Packaged Foods and Beverages in Addis Ababa, Ethiopia
Authors: Megan E Henry, Mengkun Chen, Matti Marklund, Nebiyou Fasil, Hanna Y Berhane, Seada Beyan, Kathryn Foti, Neha Khandpur, Lawrence J Appel
Journal: Circulation (2023)

Introduction: Noncommunicable diseases (e.g. type 2 diabetes, hypertension, cardiovascular disease) are the leading cause of death globally and among adults in Ethiopia. Suboptimal diet (with high intake of sugar, salt, and saturated fat) is a major risk factor for such diseases and the consumption of processed foods rich in these nutrients is rising globally. Mandatory nutrition information on packaged foods, potentially with warning labels, can guide consumers and create healthier food environments. However, such information is lacking in many countries, including Ethiopia. Hypothesis: We assessed the hypothesis that the display of nutrition information (including sugar, sodium, and saturated fat) would be low on packaged foods and beverages in Ethiopia. Methods: A database of packaged foods was created in 2021 from an assessment across 18 markets within Addis Ababa, Ethiopia. The analysis included 1388 products in four major food categories (cereals; snack foods; sweets; and beverages). Results: In total, 880 (63%) products displayed nutrient content information. This was most common among cereals (73%), and least common in snack food (43%) (Table 1). For specific nutrients, the display of sodium/salt (38%) was similar to sugar (35%) and saturated fat (34%). This discrepancy was highest in the beverages category. Conclusion: Nutrition labeling was incomplete in four major packaged food categories in Ethiopia. Fewer than half of snack foods displayed any nutrient content information, and while nearly three-fourths of cereals had some label, data on all three nutrients (sugar, sodium, and saturated fat) was missing on more than half of these products. Mandatory warning labels will allow consumers to assess the nutrient content of packaged foods and may encourage reformulation by industry to meet consumer demand and avoid placement of warning labels on their products.